MEDICARE: DR. MARTHA JENKINS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	CHIA-629	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C3704	OTHER	ID	BLUE CROSS PIN
2	000010019263	OTHER	ID	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1447250444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA JENKINS D.C.

Provider Business Mailing Address
First Line	:	4696 OVERLAND ROAD
Second Line	:	SUITE 182
City	:	BOISE
State	:	ID
Zip	:	83705
Country	:	US
Telephone Number	:	208-323-8315
Fax Number	:	208-345-5260

Provider Business Practice Location Address
First Line	:	4696 OVERLAND RD
Second Line	:	SUITE 182
City	:	BOISE
State	:	ID
Zip	:	83705-2845
Country	:	US
Telephone Number	:	208-323-8315
Fax Number	:	208-345-5260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MARTHA JENKINS D.C.” Practice Location

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